In Defense Of Patients Who Make Lists Of Their Symptoms

October 17, 1985|By G. Timothy Johnson, M.D.

Dear Readers: The Sept. 12, 1985, issue of the New England Journal of Medicine contains a delightful article by Dr. John F. Burnum from Tuscaloosa, Ala. The article addresses the age-old question of whether or not patients who write down their symptoms and complaints and then bring this list to the doctor are at higher risk for being neurotic.

Dr. Burnum argues otherwise from his own extensive and carefully noted experience, concluding, ``I have established my main point . . . that note writing does not axiomatically equate to mental illness, that the majority of note writers are emotionally sound.``

Note writing can be useful to both patient and doctor, he says. ``Let us hereafter grant note writers clinical absolution. Patients are free to write lists, to mime or sing their concerns. Medical care turns on communication. Whatever helps patients express themselves and helps physicians understand patients is acceptable. Now, Aesculapius (the Greek god of healing), stand up for note writers!``

Dear Dr. Johnson: Is it true that the oral polio vaccine actually can lead to polio?

It is true that the oral polio vaccine, which uses a live but weakened version of the polio virus to stimulate resistance, in rare instances can lead to actual cases of polio in either the recipient of the vaccine or people who come in contact with the individual who has received the vaccine.

However, it is a matter of perspective, and here the perspective clearly favors the use of the vaccine. In pre-vaccine days there were more than 20,000 cases of paralytic polio in the U.S. each summer and fall; today there are between 5 and 10 cases a year.

The risk of contracting polio from the vaccine itself is approximately 1 per every 3.3 million doses of the vaccine given, extremely small considering the enormous benefit from the vaccine.

Dear Dr. Johnson: Is estrogen effective in helping to prevent bone loss any time after menopause?

Studies clearly indicate estrogen is most effective in preventing bone loss early in menopause. When taken later--10-15 years after the onset of menopause--they have much less effect.

Dear Readers: Far too many deaths are from preventable causes.

Dr. James Mason, director of the U.S. Centers for Disease Control, noted recently that well over half of the years of life lost before age 65 in this country result from preventable deaths--64.7 percent, according to an investigation undertaken at Emory University in Atlanta.

He wrote in the Sept. 20, 1985, issue of the Journal of the American Medical Association that, ``Smoking, alcohol, injury and unintended pregnancy are the highest priority risk factors. They are followed by obesity and improper nutrition, handguns, and dental risks.``